Improving the quality of health care

Explore the efforts we’re taking to raise the standard of medical care.

Better health care

Setting the bar for a higher quality of health care is important to us. And with each patient, we have the opportunity to improve the Sharp Experience by delivering high-quality care and service. Learn about the progress we’re making, our current goals, and how we’re tracking our efforts.

Seeing results already

According to the clinical measurement results from the Healthcare Effectiveness Data and Information Set, we’ve already made great progress. Our effectiveness for Chlamydia Screening in Women and Timely Prenatal and Postpartum care has already increased. And we won’t stop there. We’re committed to exceeding expectations for all clinical measures so that Sharp Heath Plan members can get the best possible care available.

Current goals

We believe that by defining our goals in a clear and concise way, we can make major efforts in our quest to improve health care. Take a look at the ones we are most focused on achieving right now:

Deliver quality care and services that set community standards

Fulfill and exceed members’ expectations of care

Give members care that is compassionate and effective

Make it easier to get care while staying within the financial means of members

Efforts and programs

To help us reach our goals, we’ve started a few practices and programs that we believe can impact the quality of health care in a positive and effective way.

Safety first

One of our specific goals is to create a more collaborative and secure healthcare environment. And to do this, we have begun to closely monitor clinical performance indicators, validate provider credentials, and track the coordination of care to ensure a safe delivery system. Through patient safety we can reduce medical errors, which will result in higher standards of care.

Emphasizing preventive health

Part of improving the quality of care begins with members becoming familiar with preventative health guidelines. That’s why we’ve created checklists for women, men, teens, and children to help them plan effective care and treatment with their doctors.

Making it easy on providers and members

Another effort of ours is to make sure our provider network is large enough for members to get healthcare services in a more convenient and easier way. To check and see if we are fulfilling our duties, we send out a yearly survey to providers in our network. Based on their answers and feedback, we can take steps to ensure a better experience for both doctors and members.

Programs for managing health concerns

It’s important that our members have resources to help them understand how they can better manage their health. We’ve started programs for Disease Management and Case Management so that members can have helpful educational resources or talk to someone about their or a loved one’s condition. To learn more about these programs, email customer.service@sharp.com, fill out a referral form on SharpConnect, or call Customer Care at 1.855.995.5004

Preventive Health and Clinical Practice GuidelinesPreventive health guidelines are reviewed and updated using the most current and reasonable published medical evidence and the U.S. Preventive Services Task Force recommendations. The Preventive Health Services Medical Benefit Policy for all ages can be found here. Clinical practice guidelines encompass acute and chronic care relevant to Sharp Health Plan’s membership. Preventive and clinical practice guidelines are available to practitioners in the Sharp Health Plan Provider Operations Manual and can also be found on our Clinical Resources page.

Health Management ProgramsSharp Health Plan monitors health care provider compliance with California laws regarding timely access to care. Sharp Health Plan is responsible for ensuring that the provider network is sufficient to ensure accessibility, availability and continuity of covered health care services. Sharp Health Plan is also responsible for ensuring members receive covered services in a timely manner. The Industry Collaborative Effort (ICE) Provider Satisfaction with Access Survey is completed annually for doctors in contracted medical groups. The Provider Access Appointment Availability Survey is also completed each year. Health Management Programs Sharp Health Plan’s Disease Management and Case Management programs are available to meet the health care needs of members with complex health conditions or diseases through communication, education and resources. If you would like more information about our Disease Management and Case Management Programs, please contact Customer Care at (858)499-8300, 1-800-359-2022 or customer.service@sharp.com.

Tracking performance

What is Healthcare Effectiveness Data and Information Set (HEDIS®)?

HEDIS is a commonly-used set of health care performance measures in the U.S. It measures 75 aspects of care in the following categories:

Effectiveness of care

Access/availability of care

Use of services

Cost of care

With the measurement results from HEDIS, the health care field can find areas that need improvement and take steps for making the quality of care better for members and staff.

What is Consumer Assessment of Healthcare Providers and Systems (CAHPS®)?

Another way we assess the healthcare experience is through the CAHPS survey. Every year the survey is sent to our members so that they can review us and their doctors as well as rate the quality of care they've received. Based on these results, we can find out what we need to fix and work with our doctors to improve the patient experience.